Frequently Asked Questions

If their pregnancy sickness symptoms are much worse than you were expecting and they're suffering from persistent nausea and/or vomiting which is preventing them from eating and/or drinking, then they may be suffering from hyperemesis gravidarum (HG). With ordinary nausea and vomiting of pregnancy (NVP), the sickness does not interfere with a person's ability to eat and drink enough, they should not be losing weight and they should be able to care for themselves and their family as normal, although, they may not be feeling too great. With HG, sufferers often need help caring for themselves, never mind look after their family. The illness can be completely debilitating for weeks or even months.

Currently in the UK hyperemesis gravidarum is not often diagnosed until the person suffering has been admitted to hospital, however, research suggests that many more people should come under the diagnosis of HG even though they have managed to avoid actual admission to hospital, while other people are experiencing frequent admissions and never receive the diagnosis of hyperemesis. It is still unclear for some healthcare professionals where the boundaries lie with a diagnosis, but a definition was agreed in 2021 that hyperemesis gravidarum should be given as a diagnosis when symptoms start in early pregnancy (before 16 weeks gestational age); nausea and vomiting is occurring where at least one of which is severely impacting the ability to eat and/or drink normally; and strongly limits daily living activities. Signs of dehydration were deemed contributory for the definition for hyperemesis gravidarum. Diagnosis is important as they will inevitably become dehydrated and will need to be admitted to hospital for intravenous rehydration. Malnutrition is another risk.

It can be hard for those who feel so intensely nauseous to speak up for themselves and you may find they are unable to express the distress they are feeling adequately to the doctors or midwives. It can help if you speak up for them and advocate on their behalf as you are likely the only person who sees how ill they are.

Prepare in advance of an appointment by making notes of the following points:

• How many times a day are they vomiting?

• How much fluid and food have they kept down in the last 24 hours?

• How often are they passing urine?

• Have they lost much weight?

• What other symptoms are they experiencing, for example, dizziness, headaches, etc?

• Is movement, sound, and smell triggering vomiting?

• How does this differ from what you, as a couple, expected to experience in early pregnancy?

Then list your main concerns ie:

• That they are severely dehydrated?

• That they have lost so much weight?

• That your baby is at risk from the dehydration and starvation?

• That they are getting depressed from the isolation and relentless sickness?

• That there is a risk either of you could lose your jobs due to them needing so much care at home?

Finally think about any questions you would like to ask the doctor:

• Is it safer to take medication or not to take medications?

• If you are not being admitted now, then at what point should you go to hospital?

• What signs and symptoms should you look out for that things are more serious?

• What is the best route for speaking to the GP? Can you email or phone to speak to them?

• Are there other medication options and routes, such as, injections, suppository, melts?

Hopefully if you prepare well and approach the doctor with an open minded and supportive approach you will get the help you both need.

It is not uncommon for people to get depressed and anxious while suffering hyperemesis. It is not surprising considering how severe and relentless the symptoms can be. Combined with an emotion loss of a “happy, healthy pregnancy” and the inevitable isolation of the condition it is understandable how it can rapidly take its toll.

For emotional support you can suggest your partner seek support via our volunteer network, where they can have a peer supporter who has been through HG and can provide emotional support. You can read more here.

You may need some additional support yourself, it is very hard to witness a loved one going through such a difficult pregnancy. We have a partners/carers support service which we encourage you to use, read more here. 

If the depression is getting more severe, or is continuing beyond their symptoms resolving then you should encourage and support them to seek help. Encourage them to seek help from their GP who can make a referral to the perinatal mental health team. We have an inhouse counselling service which you can start the referral for here, our trained counsellors understand the complexities of HG and can provide an insightful service suited to their personal needs.  An organisation called PANDAS can also offer support and understand that hyperemesis is a severe condition which can debilitate ones life.

If you have a serious concern about your partners mental wellbeing and are worried that they may harm themselves then call the Samaritans on 116 123 or the emergency services on 999.

Having had hyperemesis gravidarum during pregnancy it can be hard once the pregnancy has come to an end to process what they have been through, the affects don't end just because the pregnancy is over. Physical symptoms can sometimes still occur but even when they don't your partner has been through a very severe condition, and it can take a while to come to terms with that; on top of all the usual new parent struggles, hormonal shifts and birth recover. Keep any eye out for the below warning signs of postnatal depression, which include but are not limited to:

• Continuous low mood or sadness
• Feeling of hopelessness and helplessness
• Low self-esteem
• Tearfulness
• Feelings of guilt
• Feeling irritable and intolerant of others
• Lack of motivation and little interest in things
• Difficulty making decisions
• Lack of enjoyment
• Suicidal thoughts or thoughts of harming someone else
• Feeling anxious or worried
• Change in appetite or weight (outside normal post-pregnancy/post-hyperemesis)
• Lack of energy or lack of interest in sex (outside normal new parent exhaustion)
• Disturbed sleep patterns and insomnia
• Taking part in fewer social activities and avoiding contact with friends
• Reduced hobbies and interests

If you suspect your partner may have postnatal depression encourage her to speak to a GP or health visitor for additional support or do so on her behalf. We have an inhouse counselling service which you can start the referral for here, our trained counsellors understand the complexities of HG and can provide an insightful service suited to their personal needs. An organisation called PANDAS will also be able to offer information and support.

If you have a serious concern about your partners mental wellbeing and are worried that they may harm themselves or others, then call the Samaritans on 116 123 or the emergency services on 999.

If you are suffering from persistent nausea and/or vomiting which is preventing you from eating and/or drinking then you may be suffering from hyperemesis gravidarum (HG). With ordinary nausea and vomiting of pregnancy (NVP), the sickness does not interfere with your ability to eat and drink enough, you should not be losing weight and you should be able to continue to care for yourself and your family although you may not be feeling too great. With HG, sufferers often need help caring for themselves, never mind look after their family. The illness can be completely debilitating for weeks or even months. There is a difference between pregnancy sickness and hyperemesis, learn more here. But with either, if it is impacting you day to day life you need to seek medical attention. 

Currently in the UK hyperemesis gravidarum is not often diagnosed until the person suffering has been admitted to hospital, however, research suggests that many more people should come under the diagnosis of HG even though they have managed to avoid actual admission to hospital, while other people are experiencing frequent admissions and never receive the diagnosis of hyperemesis. It is still unclear for some healthcare professionals where the boundaries lie with a diagnosis, but a definition was agreed in 2021 that hyperemesis gravidarum should be given as a diagnosis when symptoms start in early pregnancy (before 16 weeks gestational age); nausea and vomiting is occurring where at least one of which is severely impacting the ability to eat and/or drink normally; and strongly limits daily living activities. Signs of dehydration were deemed contributory for the definition for hyperemesis gravidarum. Diagnosis is important as you will inevitably become dehydrated and will need to be admitted to hospital for intravenous rehydration. Malnutrition is another risk.

The good news is that for the vast majority of sufferers the physical symptoms of HG disappear completely as soon as the baby is born. You should be aware though that it is not unknown for the nausea to persist after birth especially if you have been severely ill. If this occurs, speak to your doctor. For those who suffered persistent, long term nausea and vomiting, it may take some time to restore energy levels and nutritional reserves. Moreover, while the physical symptoms may leave, the trauma of HG can leave an emotional legacy for many people, especially when combined with the rigours of caring for a baby. If you have any concerns, speak to your doctor or midwife. Don't feel that you should just be able to pick yourself up and get on with things, if you're having problems you are entitled to seek support. In particular, Post Traumatic Stress Disorder (PTSD) is not uncommon after severe hyperemesis gravidarum due to the prolonged, relentless and intense suffering of the condition.

We have an inhouse counselling service which you can start the referral for here, our trained counsellors understand the complexities of HG and can provide an insightful service suited to your personal needs. 

Although there is no guarantee that you will suffer with hyperemesis gravidarum again, the research suggests that is highly likely that you will, with an 89% chance of having it again.

It is therefore important that you prepare for a 'worst case scenario'. 

Our planning page has some tips and resources for you to use to help as much as possible when preparing for a potential HG pregnancy. 

Whilst it is a scary thought having HG again, a solid care plan and your previous experience will help you feel more prepared.

Generally the reasons why some women suffer from Pregnancy Sickness and not others isn’t very clear, but one thing that is known is that Pregnancy Sickness does not arise from the baby, but from hormones produced by the placenta.

Further information:

Medical research has shown an association between the pregnancy hormone human chorionic gonadotrophin (hCG) and pregnancy sickness, although this association only holds true when several women are grouped together in the investigation, rather than for each individual pregnant woman. In addition, high maternal blood levels of this hormone occur in twin placental pregnancies and twin pregnancies are generally associated with increased pregnancy sickness. A rare condition in the Western World is a Hydatidiform Mole, in which the afterbirth is abnormal, but more significantly, there is no normal baby present. This condition is also known to be associated with a high maternal human chorionic gonadotrophin blood levels and increased pregnancy sickness. As there is no baby present, the sickness cannot arise from the baby. There is one other pregnancy related condition in which high blood levels of hCG occur in the woman’s blood, but this condition is not associated of itself with any sickness. It is now known that the hCG in this condition is abnormal, being 100% "nicked"  and therefore has lost it's hormonal activity. Therefore, at present hCG can be considered to be associated with the cause of nausea and vomiting in pregnancy (N.V.P.).

It is remarkable that the hormone hCG has, by electrophoresis, been shown to occur in at least 5 different isoforms or ‘types’. In very early pregnancy, 6-10 weeks, the type with an ‘acidic basis’ is more prominent, whereas, by 11-15 weeks of pregnancy the more ‘basic’ type of hCG becomes the more prominent of the isoforms. It has been shown that the acidic type of hormone is the most active form of the hormone. This active acidic type of hCG has been shown to be present in higher quantities in women who have hyperemesis gravidarum (the most severe form of pregnancy sickness) than in normal pregnancy.

If hCG itself is associated with the condition, perhaps because the maternal blood level of hCG is rising rapidly in early pregnancy, 6-10 weeks, some other hormone which stimulates hCG production in early pregnancy, may cause pregnancy sickness. At present, we know of eleven locally acting hormones which stimulate the secretion and release of hCG from afterbirth cells. The only two of them known to cause sickness in pregnancy are called Prostaglandin E2 and F2alpha. One further investigation has shown that more Prostaglandin E2 is present in maternal blood when pregnant women are feeling sick than when they are not feeling sick on the same day. Obviously, more investigation is needed into this under-funded and under-researched condition before we can be definite the association of acidic hCG and Prostaglandin E2 with pregnancy sickness. It may be that we have been able to show there are grounds for believing pregnancy sickness is a physical hormone based condition, rather than purely a somatic or mind over matter reaction to a stressful condition.

There are at least 12 hormones and at least one significant enzyme produced by placental cells which can affect pregnancy sickness. The production of each of these can vary from one pregnancy to the next. Recent medical research has shown the recurrence rate for hyperemesis gravidarum in subsequent pregnancies to be as high as 89%.

Further information:

To cut a long story short, the pregnancy hormone, human chorionic gonadotrophin (hCG) has been associated with nausea and vomiting in pregnancy (N.V.P) by investigations, which include a number of women. However, there is one rare condition which is associated with high hCG blood levels, but is not associated with any sickness. As N.V.P in early pregnancy is related to rapidly rising maternal hCG blood levels, we need to look for the cause of N.V.P at other locally acting hormones which stimulate the synthesis (production) of hCG. There are, at our present state of knowledge, eleven locally acting hormones or cytokines all produced by placental (often called afterbirth) cells, which stimulate hCG synthesis. There are also at least 5 known variations of hCG itself. The only one of these locally acting hormones, which is known to cause sickness, is a group called Prostaglandins, of which Prostaglandin E2 (PGE2) and Prostaglandin F2 alpha (PGF2a) are constantly present during early pregnancy. There is an enzyme produced in some placental cells called Prostaglandin dehydrogenase (PGDH), which breaks down or inactivates these prostaglandins. The amount of these anti-prostaglandins in placental cells varies from one pregnancy to another and also increases in quantity as the pregnancy progresses.

There are then many hormones produced by the placenta that can vary in quantity from one pregnancy to another and be associated with different degrees of severity of N.V.P in each individual pregnancy. More research and more funding is needed for further progress to be made to explain clearly this surprising and important subject. We may notice that N.V.P recurs similarly from one pregnancy to the next in about ½ - ¾ of succeeding pregnancies in the same person. Furthermore, recent medical research has shown the recurrence rate for Hyperemesis Gravidarum in subsequent pregnancies to be as high as 70-80%.

For further information on this topic see our literature review, section 8.

Yes, it has been documented that up to 94% of pregnancies will involve a degree of nausea and or/vomiting, but for most it is a manageable side effect of pregnancy that can be well managed with some lifestyle or diet changes, and/or first line medication. 

However, in its extreme form, hyperemesis gravidarum (HG) has much more serious complications and risks, HG is therefore considered a complication of pregnancy rather than a normal part of it.

For decades nausea and vomiting in pregnancy is associated with a good prospect for a successful outcome for the pregnancy. It is a rite of passage for most and a welcome symptom for those trying for a baby. There are no specific complications of pregnancy related to pregnancy sickness. However, those with severe hyperemesis gravidarum may be assessed for a low-birth-weight baby, although not a premature baby. The problems with any pregnancy sickness are that repeated vomiting needs to be monitored for signs of developing dehydration and the persistent nausea can make limit food and fluid intake and make you diabolically ill. Untreated hyperemesis gravidarum carries obvious risks, for example dehydration and malnutrition, and treatment of this condition is vital to ensure the health of the parent and baby.

This is a very difficult question to answer. The hormone hCG has a variety of 5 different forms. These are made by two enzymes produced by afterbirth cells. Only one form of this hCG is closely related to pregnancy sickness. Maybe this specific form of the hormone is occasionally produced later into the pregnancy?

More information:

We cannot give a definite answer to this important question at present. However, we have mentioned in the short answer that there are at least 5 different forms of the hormone human chorionic gonadotrophin (hCG), the acidic form having the longer half life in maternal blood being the dominant form until the 11 th to the 15 th week of pregnancy. This form of hCG has been related to pregnancy sickness symptoms. It is speculated that this acidic form of hCG is produced within placental (after-birth) cells by the effect of the intracellular enzymes glycosidases and glycosyltransferase acting on intracellular precursors of hCG. Deletion of sialyl-transferase and increased sialidase activity are considered likely causes of the production of the acidic form of hCG. To get a better understanding we need to investigate the blood samples of women who are having these prolonged symptoms of pregnancy sickness to find out if these assumptions bear any relationship to the truth.

The duration of pregnancy sickness is variable. Yes, it can stop before week 12 from last menstrual period (LMP) in about 60% of pregnant people according to one investigation, but only 27% in another investigation.

Even when NVP starts early after LMP or severely, it usually ends between weeks 12-14 from LMP.
NVP stops quite suddenly in approximately 30% of people.
Please bear in mind though for a few people nausea and vomiting may not stop until the delivery of the placenta.

With hyperemesis gravidarum (HG), the situation is slightly different. Like NVP it is usually worse in the first trimester and can end in weeks 12-14, however, the majority of HG sufferers find that it carries on for longer. The HER foundation has results from a self-reported poll on the duration of nausea and vomiting which shows that only around 11% of those with HG reported that nausea and vomiting had stopped before 15 weeks. 45% of those who have had HG report that they suffered nausea and vomiting past 30 weeks. Unfortunately, some people suffer severely for the entire pregnancy. Others find that it improves, but they suffer from nausea and occasional vomiting until birth.

Despite numerous studies looking at this subject there is no conclusive evidence proving that pregnancy sickness is worse with either sex. Some studies show a slightly higher percentage of those with HG having girls but the difference is not significant enough to draw that conclusion. 

Yes, there is evidence that pregnancy sickness and hyperemesis gravidarum is more common and can be more severe in twin pregnancies.

Pregnancy sickness can have a profound impact on sufferers and coping with it can be a real challenge, particularly if you have small children at home already. Please go to the 'Our services' page to see how you can speak to a member of our support team who can provide you with information and talk you through the next steps to get the treatment you need. Our website also has a whole host of information on treatments, coping strategies and how to access our peer support network.

It is a common belief that medications in pregnancy are not safe for the baby and that you must simply put up with nausea and vomiting in pregnancy. That is not true. There are a variety of safe treatments available for nausea and vomiting in pregnancy and in its severe form, hyperemesis gravidarum which may prove very dangerous if left untreated. Please see our treatment page for further information about what is available.

The following are deemed as alternative therapies for nausea and vomiting in pregnancy. Please note if you have hyperemesis gravidarum these alternatives are very unlikely to work. HG is a serious complication of pregnancy that if left untreated by proper medication can have serious and sometimes fatal consequences for the pregnant person and/or baby.

Seabands

Stimulation of the P6 point, located three fingers breadth above the wrist, has been used for many years to treat nausea from a variety of causes. Trials of a non-blinded randomised nature have shown a decrease of persisting nausea by at least 50%. Bands worn at the wrist (e.g. Sea Bands) that apply pressure may be a simple way of stimulating the P6 point. There are no theoretical concerns about the safety of acupressure in pregnancy. Long term use throughout pregnancy may cause minor markings on the wrists.

Acupuncture/hypnotherapy

Some people seem to find help by alternative medicine, particularly hypnotherapy and acupuncture. Some people claim to have had the illness ‘stopped in its tracks’ by acupuncture, but success varies between individual patients, and it tends to be expensive. These remedies are worth a try if you can afford it; however, it is best to have a back-up plan in case it doesn’t work.

Ginger

The conclusion from 6 randomised controlled trials with a total of 675 participants was that ginger extract at 1000 mgs per day may be effective treatment for nausea and vomiting in pregnancy. However, the small number of patients in these studies allocated to receive ginger (303) may have been insufficient to properly test the safety of ginger with regards to pregnancy outcome. Ginger is a non-regulated food product and most preparations available are of variable purity and composition, so dose is uncertain. Side effects include heartburn and thromboxane synthetase inhibition i.e. inhibits platelet aggregation. Survey work conducted via our charity of over 500 women's experience of being offered and taking ginger for hyperemesis gravidarum found that it was ineffective and could cause harm. Not only did ginger produce unpleasant side effects which could exacerbate symptoms but the psychological impact of being told to take ginger repeatedly was very detrimental to well-being. Where healthcare professionals recommended ginger to women with HG trust and confidence in the professional was eroded and women were left feeling dismissed and not believed.